Managing a large staghorn stone in a Doughnut kidney
Keywords:Doughnut Kidney, Renal Stone, Pyelolithotomy
Doughnut or Pancake kidney is a condition in which both the kidneys fused at the medial borders of each pole to produce a ring-shaped mass. An otherwise asymptomatic pancake kidney, may present with vague lower abdominal pain, features of urinary tract infection like pyrexia and haematuria. The diagnosis is sometimes incidental. However different imaging modalities like USG, MDCT, computed tomography (CT) urography, and radio nucleotide scanning are use confirmed the diagnosis. Different surgical options such as open pyelolithotomy laparoscopic or robot assisted pyelolithotomy can be consumed to treat such patient, however the literature proposes that an open pyelolithotomy is a safer and more rational approach to avoid injury to any aberrant vessels which are more common in such cases.
Key Words: Doughnut Kidney, Renal Stone, Pyelolithotomy
Doughnut or Pancake kidney is a condition in which both the kidneys fused at the medial borders of each pole to produce a ring-shaped mass (1). It is a very rare variant with less than 30 cases described in the literature2 wherein there is an absence of a renal capsule and fused upper and lower poles. They are typically located anterior to the aorta. Renal fusion anomalies can lead to a variety of complications, such as stone disease, infections and a variety of both benign and malignant tumours. (2,3) The management of renal stone disease in current era is marked by the use of minimally invasive endourological procedures such as per cutaneous nephrolithotomy (PCNL) which remains the gold standard treatment for renal stones with size 2.0 cm (4). However, in the rare presence of large stones in anomalous renal moieties often make these options not universally applicable. Hence, in such peculiar situations one need to revert back to conventional open surgical procedures such as open pyelolithotomy. Conventional laparoscopic procedures have also been described in literature as a surgical management (5)As the presence of associated abnormal vasculature is common with renal anomalies, which often poses a surgical challenge in the management. We hereby present a case of the ectopic pelvic pancake kidney with renal stone disease successfully managed with open pyelolithotomy. To the best of our knowledge this is first such case to be reported in our region.